Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections: A Prospective Randomized Clinical Trial
OBJECTIVES:Recently, most lumbar spine injections have been administered under ultrasound (US) guidance; however, there is no standard method for US-guided lumbar transforaminal epidural injection (TFEI). In this study, we evaluated the accuracy, effect on pain relief, and safety of US-guided lumbar...
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| Veröffentlicht in: | The Clinical journal of pain 2016-02, Vol.32 (2), p.103-108 |
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| container_title | The Clinical journal of pain |
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| creator | Yang, Ge Liu, Jinfeng Ma, Liangjuan Cai, Zhenhua Meng, Chao Qi, Sihua Zhou, Huacheng |
| description | OBJECTIVES:Recently, most lumbar spine injections have been administered under ultrasound (US) guidance; however, there is no standard method for US-guided lumbar transforaminal epidural injection (TFEI). In this study, we evaluated the accuracy, effect on pain relief, and safety of US-guided lumbar TFEI.
METHODS:A total of 80 patients with low back pain and radicular pain were enrolled. The patients were randomly assigned to either the fluoroscopy (FL) group or the US group. The FL-guided approaches were performed under standardized procedures using the C-arm, whereas the US-guided injections were performed with an US device with a linear probe, and were verified by FL. The needle tip reached the lateral side of the lamina in the axis view and the middle of the adjacent facet joints in the parasagittal view. Afterward, the needle was advanced slightly deeper until the loss-of-resistance test was positive.
RESULTS:The success ratio of the US-guided interventions was 85%. The operation time in the US group (518±103 s) was shorter than the FL group (929±228 s) (P |
| doi_str_mv | 10.1097/AJP.0000000000000237 |
| format | Article |
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METHODS:A total of 80 patients with low back pain and radicular pain were enrolled. The patients were randomly assigned to either the fluoroscopy (FL) group or the US group. The FL-guided approaches were performed under standardized procedures using the C-arm, whereas the US-guided injections were performed with an US device with a linear probe, and were verified by FL. The needle tip reached the lateral side of the lamina in the axis view and the middle of the adjacent facet joints in the parasagittal view. Afterward, the needle was advanced slightly deeper until the loss-of-resistance test was positive.
RESULTS:The success ratio of the US-guided interventions was 85%. The operation time in the US group (518±103 s) was shorter than the FL group (929±228 s) (P<0.05). In addition, the radiation dosage in the US group (2640±906 μGy m) was lower than in the FL group (8992±2132 μGy m). There was no significant difference in pain relief between the US and FL groups. No serious complication was observed in any of the patients in either group.
DISCUSSION:Lumbar TFEI under US guidance was feasible, safe, and required less radiation to achieve the same benefit as the FL-guided interventions.</description><identifier>ISSN: 0749-8047</identifier><identifier>EISSN: 1536-5409</identifier><identifier>DOI: 10.1097/AJP.0000000000000237</identifier><identifier>PMID: 25803759</identifier><language>eng</language><publisher>United States: Copyright Wolters Kluwer Health, Inc. All rights reserved</publisher><subject>Adult ; Aged ; Analgesics - administration & dosage ; Female ; Fluoroscopy - standards ; Guidelines as Topic - standards ; Humans ; Injections, Epidural ; Low Back Pain - diagnostic imaging ; Low Back Pain - drug therapy ; Lumbar Vertebrae - diagnostic imaging ; Lumbar Vertebrae - drug effects ; Male ; Middle Aged ; Pain Measurement ; Prospective Studies ; Radiculopathy - diagnostic imaging ; Radiculopathy - drug therapy ; Ultrasonography, Interventional - standards ; Young Adult</subject><ispartof>The Clinical journal of pain, 2016-02, Vol.32 (2), p.103-108</ispartof><rights>Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3057-e1478bfbf8512693ada07e03083ad66f295fcc43f2d3ab9cfc6a668054560a0f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25803759$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yang, Ge</creatorcontrib><creatorcontrib>Liu, Jinfeng</creatorcontrib><creatorcontrib>Ma, Liangjuan</creatorcontrib><creatorcontrib>Cai, Zhenhua</creatorcontrib><creatorcontrib>Meng, Chao</creatorcontrib><creatorcontrib>Qi, Sihua</creatorcontrib><creatorcontrib>Zhou, Huacheng</creatorcontrib><title>Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections: A Prospective Randomized Clinical Trial</title><title>The Clinical journal of pain</title><addtitle>Clin J Pain</addtitle><description>OBJECTIVES:Recently, most lumbar spine injections have been administered under ultrasound (US) guidance; however, there is no standard method for US-guided lumbar transforaminal epidural injection (TFEI). In this study, we evaluated the accuracy, effect on pain relief, and safety of US-guided lumbar TFEI.
METHODS:A total of 80 patients with low back pain and radicular pain were enrolled. The patients were randomly assigned to either the fluoroscopy (FL) group or the US group. The FL-guided approaches were performed under standardized procedures using the C-arm, whereas the US-guided injections were performed with an US device with a linear probe, and were verified by FL. The needle tip reached the lateral side of the lamina in the axis view and the middle of the adjacent facet joints in the parasagittal view. Afterward, the needle was advanced slightly deeper until the loss-of-resistance test was positive.
RESULTS:The success ratio of the US-guided interventions was 85%. The operation time in the US group (518±103 s) was shorter than the FL group (929±228 s) (P<0.05). In addition, the radiation dosage in the US group (2640±906 μGy m) was lower than in the FL group (8992±2132 μGy m). There was no significant difference in pain relief between the US and FL groups. No serious complication was observed in any of the patients in either group.
DISCUSSION:Lumbar TFEI under US guidance was feasible, safe, and required less radiation to achieve the same benefit as the FL-guided interventions.</description><subject>Adult</subject><subject>Aged</subject><subject>Analgesics - administration & dosage</subject><subject>Female</subject><subject>Fluoroscopy - standards</subject><subject>Guidelines as Topic - standards</subject><subject>Humans</subject><subject>Injections, Epidural</subject><subject>Low Back Pain - diagnostic imaging</subject><subject>Low Back Pain - drug therapy</subject><subject>Lumbar Vertebrae - diagnostic imaging</subject><subject>Lumbar Vertebrae - drug effects</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pain Measurement</subject><subject>Prospective Studies</subject><subject>Radiculopathy - diagnostic imaging</subject><subject>Radiculopathy - drug therapy</subject><subject>Ultrasonography, Interventional - standards</subject><subject>Young Adult</subject><issn>0749-8047</issn><issn>1536-5409</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1P3DAQhi3Uqiy0_wBVOfYSmMTxR7itVlBAKxWhpdfIcexicOzUjovgyC_HaKGqesAXjzXPvNY8CB1UcFhBy46WF5eH8O-pMdtBi4pgWpIG2g9oAaxpSw4N20V7Md4CVKTm8Ant1oQDZqRdoKdrOwcRfXJD-SuZQQ3FTxViisWpTT74KP30UErv5uCtzd11GnsRik0QLmofxGicsMXJZIYUcnHubpWcjXfxuFgWlzlgenn_UcWVcIMfzWPOWFnjjMz0JhhhP6OPWtiovrze--j69GSzOivXP76fr5brUmIgrFRVw3ive81JVdMWi0EAU4CB55JSXbdES9lgXQ9Y9K3UkgpKOZCGUBCg8T76ts2dgv-dVJy70USprBVO-RS7ilHgLc1eMtpsUZkXiEHpbgpmFOGhq6B7sd9l-93_9vPY19cfUj-q4e_Qm-4M8C1w7-2cNd_ZdK9Cd6OEnW_ez34GeOmTqQ</recordid><startdate>201602</startdate><enddate>201602</enddate><creator>Yang, Ge</creator><creator>Liu, Jinfeng</creator><creator>Ma, Liangjuan</creator><creator>Cai, Zhenhua</creator><creator>Meng, Chao</creator><creator>Qi, Sihua</creator><creator>Zhou, Huacheng</creator><general>Copyright Wolters Kluwer Health, Inc. All rights reserved</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201602</creationdate><title>Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections: A Prospective Randomized Clinical Trial</title><author>Yang, Ge ; Liu, Jinfeng ; Ma, Liangjuan ; Cai, Zhenhua ; Meng, Chao ; Qi, Sihua ; Zhou, Huacheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3057-e1478bfbf8512693ada07e03083ad66f295fcc43f2d3ab9cfc6a668054560a0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Analgesics - administration & dosage</topic><topic>Female</topic><topic>Fluoroscopy - standards</topic><topic>Guidelines as Topic - standards</topic><topic>Humans</topic><topic>Injections, Epidural</topic><topic>Low Back Pain - diagnostic imaging</topic><topic>Low Back Pain - drug therapy</topic><topic>Lumbar Vertebrae - diagnostic imaging</topic><topic>Lumbar Vertebrae - drug effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pain Measurement</topic><topic>Prospective Studies</topic><topic>Radiculopathy - diagnostic imaging</topic><topic>Radiculopathy - drug therapy</topic><topic>Ultrasonography, Interventional - standards</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yang, Ge</creatorcontrib><creatorcontrib>Liu, Jinfeng</creatorcontrib><creatorcontrib>Ma, Liangjuan</creatorcontrib><creatorcontrib>Cai, Zhenhua</creatorcontrib><creatorcontrib>Meng, Chao</creatorcontrib><creatorcontrib>Qi, Sihua</creatorcontrib><creatorcontrib>Zhou, Huacheng</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Clinical journal of pain</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yang, Ge</au><au>Liu, Jinfeng</au><au>Ma, Liangjuan</au><au>Cai, Zhenhua</au><au>Meng, Chao</au><au>Qi, Sihua</au><au>Zhou, Huacheng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections: A Prospective Randomized Clinical Trial</atitle><jtitle>The Clinical journal of pain</jtitle><addtitle>Clin J Pain</addtitle><date>2016-02</date><risdate>2016</risdate><volume>32</volume><issue>2</issue><spage>103</spage><epage>108</epage><pages>103-108</pages><issn>0749-8047</issn><eissn>1536-5409</eissn><abstract>OBJECTIVES:Recently, most lumbar spine injections have been administered under ultrasound (US) guidance; however, there is no standard method for US-guided lumbar transforaminal epidural injection (TFEI). In this study, we evaluated the accuracy, effect on pain relief, and safety of US-guided lumbar TFEI.
METHODS:A total of 80 patients with low back pain and radicular pain were enrolled. The patients were randomly assigned to either the fluoroscopy (FL) group or the US group. The FL-guided approaches were performed under standardized procedures using the C-arm, whereas the US-guided injections were performed with an US device with a linear probe, and were verified by FL. The needle tip reached the lateral side of the lamina in the axis view and the middle of the adjacent facet joints in the parasagittal view. Afterward, the needle was advanced slightly deeper until the loss-of-resistance test was positive.
RESULTS:The success ratio of the US-guided interventions was 85%. The operation time in the US group (518±103 s) was shorter than the FL group (929±228 s) (P<0.05). In addition, the radiation dosage in the US group (2640±906 μGy m) was lower than in the FL group (8992±2132 μGy m). There was no significant difference in pain relief between the US and FL groups. No serious complication was observed in any of the patients in either group.
DISCUSSION:Lumbar TFEI under US guidance was feasible, safe, and required less radiation to achieve the same benefit as the FL-guided interventions.</abstract><cop>United States</cop><pub>Copyright Wolters Kluwer Health, Inc. All rights reserved</pub><pmid>25803759</pmid><doi>10.1097/AJP.0000000000000237</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Analgesics - administration & dosage Female Fluoroscopy - standards Guidelines as Topic - standards Humans Injections, Epidural Low Back Pain - diagnostic imaging Low Back Pain - drug therapy Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - drug effects Male Middle Aged Pain Measurement Prospective Studies Radiculopathy - diagnostic imaging Radiculopathy - drug therapy Ultrasonography, Interventional - standards Young Adult |
| title | Ultrasound-guided Versus Fluoroscopy-controlled Lumbar Transforaminal Epidural Injections: A Prospective Randomized Clinical Trial |
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